Bereavement Transition of Spouses in Older Adults
Introduction
Sudden undesirable changes in the social life of human beings necessitate a change of behavior and practices and sometimes can lead to adverse health outcomes. Death is a natural event that every human being must experience. At other times, people experience the death of a loved one. Bereavement denotes the death or loss of a loved one. It leads to grief and the grief reactions exhibited by those left alive, such as yearning, intense pining, protests, and anger reactions. According to Richardson (2014), grieving due to bereavement has a wide range of effects across various health aspects, including the affective, psychological, physical, spiritual, cognitive, and social realms, among others. Bereavement of a spouse is one of the losses that cause the most significant effects. This paper focuses on the spousal bereavement of older adults aged above 65 years. At least 50 percent of all women and 10 percent of all men experience the loss of a spouse by age 65 years, and the figures rise to 80 percent and 40 percent respectively by the age of 85 years (Neimeyer & Holland, 2015). This means that 30 percent of all men and 30 percent of all women who are in marriage at age 65 lose their spouses to death by the age of 85 years. As such, this paper examines the spousal bereavement transition of older adults, its significance on their health, the nursing implications, and possible solutions.
The bereavement transition
The loss of a spouse in senior age has an extensive effect on the spouse left behind, especially if the loss comes after a long-term marriage. According to Spahni et al. (2015), the loss of a spouse in older adulthood is associated with a wide range of negative social, practical, physical, economic, and psychological consequences. These consequences force the bereaved to go through a transition in which they have to learn and adapt to living in their new reality, which is a life without their partner. The shock of losing a spouse and the forced transition leads to a wide range of responses or eventualities that can be categorized under psychosocial, existential, and familial responses.
Older adults exhibit several psychological responses when they lose a spouse. The most common psychosocial responses include grief, feelings of sadness, distress, behavioral changes, and changes in social participation (Carr et al., 2001). However, different individuals react differently in terms of the responses they display and their intensity due to several factors. They include the marriage characteristics, presence of other stressful events, nature of the spouse’s’ death, as well as social and personal resources such as economic resources, personality, and social support (Carr & Jeffreys, 2018). Spahni et al., (2015) classifies the bereaved older adults into three groups based on their psychological responses and intensity on five parameters, including depression, loneliness, life satisfaction, subjective health, and hopeless. The first group, Resilient, constitutes 54 percent of all bereaved seniors and refers to people who do not exhibit negative health outcomes after loss (Spahni et al., 2015). Copers refer to seniors who exhibit moderate negative outcomes and constitute about 39 percent (Spahni et al., 2015). The last group, the Vulnerables, constitutes only 7 percent and describes bereaved seniors with significant or severe negative outcomes (Spahni et al., 2015). It appears that only a small percentage of the elderly are affected severely psychosocially. Several factors determine an individual’s response. In addition, some elderly may exhibit hostility instead of grief (Hashim et al., 2013), while others tend to increase social participation after initial decline immediately after the spouse’s death due to support from relatives and friends (Nesse et al., 2002). Lastly, the normal grieving period in older adults after the loss is two weeks (Carr & Jeffreys, 2018).
The bereaved older adults also exhibit specific existential responses and lifestyle changes. It generates more lifestyle changes and complications for the bereaved than in the married older adults. First, studies indicate that older bereaved spouses tend to have weaker immune systems, more functional disabilities and chronic conditions, and higher morbidity and mortality rates (Richardson, 2014). This means that they require more medical attention than other bereaved spouses do. As such, they make more visits to the physician, are hospitalized more often, and spend more days in nursing homes than their married counterparts spend (Richardson, 2014). Secondly, the cognitive and self-care deficit problems also influence where the bereaved older adults live or reside. When left alone, the cognitive impairment and self-care deficit necessitate the presence of a caregiver, which could be provided by living with other family members or transfer to a nursing home or long-term care facility (Hashim et al., 2013). Overall, the economic, social, and health changes due to spousal death often interfere with the seniors’ lifestyles and living arrangements.
The death of a spouse of an older adult also produces varied familial responses. According to Hashim et al. (2013), some grieving older adults open up to their family members about their emotional changes and other challenges to receive the appropriate assistance and support. At the same time, some grieving seniors might find it difficult to ask for help from their family members because they do not wish to be a burden to the younger generation (Hashim et al., 2013). As such, they keep their suffering and emotional plight to themselves. This has two key implications. First, the family members will be oblivious of the challenges the senior is facing and the subsequent interventions that could be deployed to resolve the issues. Secondly, the lack of communication might aggravate the grief disorders or worsen other underlying conditions.
Significance of the bereavement transition
The adaptations patterns of spousal bereavement depend largely on the person’s personal resources and other environmental factors such as social support systems. Richardson (2014) observes that the older adults handle bereavement better than the middle and young adults because they have more experiences with losses and regulate their emotion better, but spousal bereavement after long-term marriage predisposes them to bereavement overload. Therefore, they exhibit various physical and mental health issues.
- Physical health
After the loss of a spouse, the surviving spouses may exhibit several physical health problems. According to Hashim et al. (2013), they can develop somatic symptoms and signs such as chest pain, headache, and palpitations. On their part, Utz et al. (2011) posit that they present with a variety of physical symptoms, including concentration problems, fatigue, loss of appetite, and sleep disturbances, which subside or diminish within the first and half years following the loss of a spouse. These symptoms are not present before the loss. Rather, they develop after bereavement. As such, Utz et al. argue that they rarely suggest or indicate any underlying physical disorder and therefore are typical to the grieving experience as depressive symptoms and grief are typical responses to the loss of a spouse. This means that the above symptoms do not indicate any physical disease. However, Hashim et al. (2013) warn that careful consideration is needed in such cases because the symptoms could be indicative of an underlying depression, which is a complication of grief. Therefore, screening is needed to distinguish between normal grief symptoms and depression, which is based on prolonged and intensified symptoms. Nonetheless, the depression and grief diagnoses are not part of the physical health but rather the mental aspect of health.
Apart from grief and depressive somatic symptoms, the older adults who lose their spouses also present with greater physical health problems. According to Richardson (2014), grieving spousal loss in older adulthood has been associated with the weakening of the seniors’ immune systems. This means they are more vulnerable to all forms of infection than their married counterparts and younger bereaved persons. In addition, the bereaved seniors have more functional disabilities and chronic conditions, and higher morbidity and mortality rates than their married counterparts (Richardson, 2014). This means that they suffer more health problems. It is also vital to note that these grieving spouses could have some preexisting health conditions that can worsen due to bereavement leading to greater comorbidity, disease severity, and even death (Richardson, 2014). A survey conducted across Europe showed that grieving older adults of over 65 years are three times more likely than the middle and young adults to die within a year of their spouse’s death (Independent Age, 2018). This might be due to the weakening of the elder’s immunity and other depression complications that compromise health. In addition, lack of appetite and other depression symptoms can lead to malnutrition.
- Mental health
Grieving older adults experience psychological changes and wellbeing modifications that are evidenced by the symptoms of grief and depression. The experience can result in various mental health problems, which, according to literature, include Complicated Grief, Major Depressive Disorder, and anxiety disorders. Most of the seniors are able to manage their grief and overcome it, but approximately 10 percent experience complicated or prolonged grief, which can be diagnosed as complicated grief (Hashim et al., 2013). Grief is normal and healthy, while complicated grief is a complication. The former describes feelings of yearning, searching, crying, disbelieving and feeling shocked by the loss, and being preoccupied with persistent thoughts of the deceased (Hashim et al., 2013). On the other hand, complicated grieve exhibits all the above symptoms for a longer period than usual and has a characteristic feeling of hopelessness and worthlessness (Hashim et al., 2013).
Depression is another mental health complication. Although most of the seniors show resilience and exhibit diminished stress and grief symptoms, some individuals may present with prolonged grief that turns out to be Major Depressive Disorder (MDD) (Utz et al., 2011). While grief is an acute emotional response directed specifically at the loss of the deceased, MDD refers to a more general negative effect symptomatology (Kavan & Barone, 2014). This means that the depressed individual is in a general state of negative affect that is not related to the loss. The depressed spouses also exhibit impaired self-care, delusions and hallucinations, and suicidal thoughts (Kavan & Barone, 2014). The anxiety disorders associated with the loss of a spouse in older adulthood include Generalized Anxiety Disorder, Panic Disorder, and Post-Traumatic Stress Disorder (Neimeyer & Holland, 2015).
Nursing implications and roles
Several nursing implications and roles emerge in the context of this topic. First, the bereavement support offered to the surviving partner should not focus on emotional support only, but also self-care support and health promotion, especially in persons with preexisting health problems because they are susceptible to intense and prolonged clinical distress (Utz et al., 2011). This means the nurse should provide holistic care, which necessitates interdisciplinary collaboration. As such, the nurse’s assessment should cover the physical, emotional, mental, psychological, socioeconomic, and spiritual dimensions of the surviving elderly spouse. According to Oates & Maani-Fogelman (2019), a good assessment would rely on creating a good rapport with the senior and family members and encouraging them to speak openly and honestly concerning their physical issues and emotions. A good assessment provides accurate and relevant information for developing interventions. It also helps capture other underlying health conditions and factors (Oates & Maani-Fogelman, 2019).
Secondly, the nurse is tasked with providing compassionate care and interventions to the patient and his or her family as well (Oates & Maani-Fogelman, 2019). As such, the care also extends to the family, which the nurse should also use to provide support the patient. Thirdly, the nurse needs to provide personalized care because of two reasons. First, different people handle grief differently. As such, each will present with his or her special needs and strengths. Secondly, different patients or clients will be at various stages of grief, therefore, requiring different approaches. The different stages of grief include denial, anger, bargaining, depression, and acceptance (Ramos, 2011).
The literature search and review led to the following two proposed changes in the health care system to assist older adults in dealing with the death of a spouse better. First, sensitization and education programs are needed to sensitize the seniors about spousal grief and coping mechanisms. This recommendation is founded on findings by Independence Age (2018), which established that less than one in every five people individuals of over 60 years never receive any counseling following the death of a loved one with more than 50 percent claiming that counseling did not have tangible benefits. The study explained this in terms of generational attitude. Nonetheless, they need sensitization. The other generations need sensitization as well because they are the future group of older adults. The second recommendation involves creating local community teams. According to Holm et al. (2019), healthcare professionals need to enlist the help of local community groups to satisfactorily address the emotional and physical health issues of the surviving widowed seniors as well as the social and environmental factors that influence their health. This strategy will address actual health problems as well as promote health. More information is necessary for understanding various subgroups of the bereaved older adults. As such, resilience to grief complications should be studied across different ethnic groups and social classes.
Conclusion
Loss of a spouse is a major life event that has a wide range of impacts on the lifestyle and health of the spouses who are left behind. Their lives are disrupted and necessitate various lifestyle and habit changes. Although the elderly have more experience with loss and death and are more emotionally controlled, losing a partner after years of living together makes them susceptible to bereavement or grief overload. Bereavement overload then leads to several mental and physical health complications if the person is not able to deal with it appropriately. The nursing fraternity thus needs to intervene directly by supporting the patients and family members, as well as indirectly by facilitating changes that address spousal bereavement in older adults better.